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NPI Code Detail

MEDICARE: MR. HENRY O EDOBOR

MEDICARE: MR. HENRY O EDOBOR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1385HR2055XChild Mental Illness Respite Care

General Provider Information

NPI Number : 1023596699
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HENRY O EDOBOR
Provider Business Mailing Address
First Line : 14927 JAMAICA AVE STE 5
Second Line :
City : JAMAICA
State : NY
Zip : 11435-4078
Country : US
Telephone Number : 718-880-1974
Fax Number : 718-880-1974
Provider Business Practice Location Address
First Line : 14927 JAMAICA AVE STE 5
Second Line :
City : JAMAICA
State : NY
Zip : 11435-4078
Country : US
Telephone Number : 718-880-1974
Fax Number : 718-880-1974
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2018
Last Update Date : 08/05/2018

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